Samantha Darlene Walters, PA-C
Physician Assistant in Jacksonville, FL. Individual provider (NPI-1).
NPI number1760144547
StatusActive
Last updated in NPPESOct 27, 2025
Details
- NPI
- 1760144547
- Entity type
- Individual (NPI-1)
- Name
- Samantha Darlene Walters
- Credential
- PA-C
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Oct 9, 2021
- Certification date
- Oct 27, 2025
- Last updated
- Oct 27, 2025
Medicare and OIG
- Medicare enrolled (PECOS)
- Yes · PRACTITIONER - PHYSICIAN ASSISTANT
- Can order and refer
- Part B Yes · DME Yes · Home health Yes · Power mobility Yes · Hospice No
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363A00000X | Physician Assistant | – | – | Yes |
Practice location
7751 Belfort Pkwy Ste 120Jacksonville, FL 32256-6921
Phone 904-372-3943
Mailing address
7751 Belfort Pkwy Ste 120Jacksonville, FL 32256-6921
Phone 904-372-3943
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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